OTL: About the painkillers study


In August 2009, ESPN's "Outside the Lines" conducted an interview with former Philadelphia Eagles defensive tackle Sam Rayburn in which Rayburn discussed his addiction to the prescription painkiller Percocet. To determine whether Rayburn's case served as a unique example, OTL conducted a review of scientific literature but found no mention of the level of prescription painkiller use by former NFL players as a whole.

As a result, the idea of a scientific study about the use of prescription pain medication among NFL players was born. From August 2009 to October 2009, ESPN reached out to substance abuse research institutes in the United States, many on the recommendation of officials with the National Institute on Drug Abuse (NIDA), a division of the federal Department of Health and Human Services. In December 2009, Linda Cottler, professor of epidemiology in Washington University in St. Louis's Department of Psychiatry, formally partnered with ESPN and agreed to oversee the research project.


Excerpts from the study that show the characteristics of retired NFL players by opioid use status while playing.

Non-users Users
Mean age in years 49.7 47.1
White/Caucasian 46% 57%
Black/African-American 51% 40%
Others 3% 3%
Offensive lineman 21% 35%
Offensive ball handler (QB, WR, RB, FB) 26% 19%
Defensive lineman 20% 20%
Defensive secondary 18% 16%
Cornerback or safety 10% 6%
Other position 6% 4%
Average number of years played 7.5 7.6
Mean years since retirement 19 16.5
Excellent health at start of career 88% 89%
Excellent health at retirement 21% 15%
Excellent health in past 30 days 17% 9%
Suffered knee injury as player 54% 67%
Suffered shoulder injury as player 34% 48%
Suffered back injury as player 36% 46%
Had 3 or more NFL injuries 38% 56%
Diagnosed concussion 48% 49%
Undiagnosed concussion 75% 86%
Had career-ending injury 49% 61%
Had injury requiring use of cane, walker or wheelchair 5% 7%
Perceived percentage of teammates who misused prescription opioids 23.4% 30.25%

Cottler and her team were the driving force, though ESPN provided funding, survey design input and is listed as a co-author of the published research. NIDA also provided research funding.

The goal of the research was to determine the past 30-day use, as well as NFL player-related use and misuse of opioids and associated risk factors. A telephone survey of retired NFL players was conducted from March 2010 to August 2010 with 644 players from the 2009 Retired NFL Players Association Directory. Among 1,184 eligible players, 7 percent refused, 38.4 percent were unreachable and 54.6 percent completed the interview. No incentives were provided for participation in the 20-minute survey

Upon completion of the phone-based survey, Cottler and her team began the process of writing a paper based on the research findings, with the intention of submitting it to a scientific journal. In November 2010, that research paper, co-authored by three ESPN journalists, was submitted to Drug and Alcohol Dependence. After weeks of peer review, the paper was accepted for publication by the journal's editors in late December and was published Jan. 28.

While the individual responses of the survey remain confidential, more than 400 of the 644 former NFL players surveyed agreed to be interviewed by ESPN. Many of those interviews serve as a foundation for OTL's reporting.

Drug misuse vs. drug abuse

While the terms "misuse" and "abuse" are often used interchangeably, within the field of substance-abuse research there are distinct criteria used to determine whether individuals misuse or abuse drugs or alcohol. In the course of conducting this phone-based survey, researchers at Washington University asked a series of specific questions aimed at determining the level of current misuse of prescription pain medications.


Excerpts from the study that show the characteristics of retired NFL players by opioid use in the past 30 days.

No use Used as prescribed Misused
Mean age in years 48.3 51 47
White/Caucasian 50% 55% 62%
African-American/other 50% 45% 38%
Currently unemployed 9% 18% 11%
Offensive lineman 27% 35% 36%.1
Offensive ball handler (QB, WR, RB, FB) 23% 20% 13%
Defensive lineman 19% 22% 27%
Defensive secondary 18% 8% 16%
Cornerback or safety 8% 6% 4%
Other position 5% 9% 4%
Mean years since retirement 17 20 17
Excellent health at start of career 88% 92% 84%
Excellent health at retirement 20% 9% 2%
Excellent health in past 30 days 15% 5% 2%
Suffered knee injury as player 60% 54% 76%
Suffered shoulder injury as player 40% 38% 58%
Suffered back injury as player 37% 60% 64%
Had 3 or more NFL injuries 43% 54% 82%
Diagnosed concussion 47% 53% 58%
Undiagnosed concussion 79% 85% 98%
Had career-ending injury 53% 65% 73%
Had injury requiring use of cane, walker or wheelchair 3% 20% 20%
Reports having no pain 8% 0% 0%
Reports having mild pain 24% 6% 4%
Reports having moderate pain 29% 22% 18%
Reports having severe pain 39% 72% 78%
Has moderate to severe physical impairment 44% 66% 73%
Has moderate to severe mental impairment 19% 37% 38%
Mean number of alcoholic drinks in past seven days 6 7 11
Had 15+ drinks in past seven days 10% 11% 31%
Had 20+ drinks in past seven days 8% 11% 27%
Perceived percentage of teammates who misused prescription opioids 25% 35% 43%

"Even misuse can be associated with overdose and death," said Dr. Wilson Compton, division director at NIDA. "These can be dangerous medications when combined with alcohol, when taken to excess ... so that's why taking them outside a medical supervision seems particularly risky to me."

While the researchers did not ask questions designed to identify what would rise to the level of abuse, "Outside the Lines," through its independent reporting and follow-up interviews with several survey respondents and others, did identify several clear-cut cases of prescription painkiller abuse by former NFL players.

The following criteria from the American Psychiatric Association are the widely accepted standards for diagnosing substance abuse.

An individual is classified as a substance abuser if any one (or more) of the following has occurred within a 12-month period:

•  Recurrent substance use resulting in failure to fulfill major obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use, substance-related absences, suspensions, or expulsions from school; neglect of children or household).

•  Recurrent substance use in situations in which it is physically hazardous (e.g., driving when impaired).

•  Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct).

•  Continued substance use despite having persistent or recurrent social or interpersonal problems caused, or exacerbated by, effects of the substance (e.g., arguments with spouse about consequences, physical fights).

John Barr is a reporter in ESPN's Enterprise Unit. He can be reached through email jbarr-espn@hotmail.com.

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